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Some children will have mild reactions to eating a food they are allergic to. They may experience watery eyes, a runny nose or hives, and then quickly recover with a dose of Benadryl®. Still others may vomit and immediately feel better. Other children will experience anaphylaxis, the most severe of allergic reactions and end up in the emergency room receiving shots of epinephrine. Tragically, some children will die.

It is difficult to estimate how many people die each year from anaphylaxis. The Food Allergy & Anaphylaxis Network (FAAN) has stated that approximately 200 people die from anaphylaxis each year in the USA from food allergic reactions. The actual figures may be much higher, especially since almost 50,000 visits to emergency rooms occur each year from allergic reactions. Five Americans die each day from anaphylaxis (from allergic reactions to medicines, food and/or insect stings).

Families who don’t deal with food allergies on a daily basis may not understand the serious nature of food allergies. How can anyone die from eating one bite of a food? Is it really necessary to read EVERY label of EVERY food that is eaten? Why can’t your child eat the cake I made for the birthday party?

If your child is severely allergic to any food, strict precautions will have to be practiced if you want your child to not experience anaphylaxis. It only takes one misstep. And even with the best precautions, products can still be mislabeled, misunderstandings can occur and EpiPens® can be out of reach. We do as much as we can to ensure our son’s safety by reading every label of every food he eats; not allowing him to eat baked goods that don’t have a label; closely monitoring foods eaten near him; carrying his EpiPen® at all times; and calling food manufacturers when we haven’t previously used the product.

Accidents can still occur, and for the food allergic child, such an accident can cause death. It is the reality of what we live with daily. We try to not focus on this; instead we try to gain an understanding of what we can learn from these tragedies. This is a preventable death, and our family does everything we can to stay safe and enjoy life.

In the April 2007 “Journal of Allergy & Clinical Immunology” research was submitted on the deaths of 31 individuals who suffered fatal anaphylaxis. Peanuts accounted for 17 of the deaths (55%); tree nuts caused 8; milk caused 4; and shrimp 2.  Epinephrine availability is a key factor in the cause of death with only 4 of the fatalities having received epinephrine in a timely fashion. The location of the deaths wasn’t known in all the instances; however the most common occurrence was at a restaurant. The authors of the research, Dr. Allan Bock, Dr. Hugh Sampson and Anne Munoz-Furlong of FAAN, cite lessons to be learned as follows: (1) education of the medical profession to ask about food allergy, diagnose it, educate patients, and prescribe epinephrine continues to be inadequate; (2) patients’ education regarding diagnosis, allergen avoidance, symptom recognition, and discrimination between asthma flares and anaphylaxis remains very inadequate; (3) patients need to inquire in detail about ingredients and avoid eating desserts and bakery goods, especially when away from home; (4) patients’ knowledge of and compliance with the importance of carrying epinephrine needs improvement; (5) availability of epinephrine to emergency medical technicians and prompt dispatch of paramedics or emergency medical technicians who can carry and administer epinephrine needs to be improved in many locales; (6) school education including food preparation and staff training needs improvement; (7) public education about the potential fatal nature of food allergy needs to be disseminated; (8) restaurant education concerning the importance of accurate labeling and the full and complete disclosure of food ingredients must be stressed to the industry; and (9) evaluation by an allergist with the identification of the specific food culprits, and detailed education of patients and their families and friends may be lifesaving.

 

What can be learned from these tragedies for those of us with food allergic children?

It seems to me that education and awareness are the footwork that is available to us all. The more people are aware that my son has severe, life threatening food allergies, the better the chance that he will not experience anaphylaxis. Telling family members, friends, teachers, etc., about his food allergies is necessary so that they realize what they eat could potentially impact him.

Secondly, my son needs to be his own advocate. Sitting next to someone eating peanut butter isn’t something that he would do at 9 years old in the school lunchroom. I hope that impressing a teenage girl won’t scramble his brain to the point that he forgets what he’s allergic to now that he’s a teenager! Learning at a young age how to advocate for his safety was something we worked on daily. Lastly, our allergist has told us that children with a dual diagnosis of asthma and food allergies have much more likelihood to experience anaphylaxis. For that reason, more precautions will have to be practiced. For better or worse, my son will have to know what his date ate for dinner, and maybe even for lunch!

A letter in the June 6, 2002 issue of “The New England Journal of Medicine” found that kissing is not an uncommon occurrence creating an allergic reaction. Rosemary Hallett, M.D., an allergist at the University of California-Davis, and her colleagues reported that 5.3% of their 379 nut-allergic patients had experienced allergic reactions after kissing another person. Most of the reactions were mild, however a few did involve breathing problems, and one child had a life-threatening reaction. Four patients reported an allergic reaction even after their kissing partner had brushed their teeth!

Dr. David Fleischer, an Allergist & Immunologist at National Jewish Hospital in Denver, told Morgan and I that Morgan could have a reaction to kissing a girl if she ate one of his allergens within the previous 2 hours. She could mitigate this issue by not eating the particular food (best choice!) or by eating some other food or brushing her teeth to remove the allergen.

The Food Allergy & Anaphylaxis Network (FAAN) has reported that teenagers are the highest risk group for fatalities from allergic reactions. Teenagers, in general, tend to believe they are invincible, and are more likely to take risks. When it comes to food allergies, they are less likely to have an EpiPen immediately available, and are no longer under the watchful and careful eye of their parents. Only 61% of teens reported always carrying their EpiPen in a “Risk Taking Study” by Dr. Hugh Sampson of Mt. Sinai Hospital.  In our house, we want 100% compliance with EpiPen carrying!

The following are the stories of several food allergic children and teenagers who died from anaphylaxis: